Report of reversed fellowship in Eritrea, Marc Lottenbach

Transcription

1 Report of reversed fellowship in Eritrea, Marc Lottenbach Introduction My wife me and were the second persons which went to Eritrea for the reversed fellow ship. I spent there for 8 weeks and my wife for 31/2 weeks. I was working during my time with the surgeons, which were in Halibet Dr. Semere and for 2 weeks with Dr. Salomon (he came back during my time in Halibet from a stage in south Africa) and in the military hospital with Dr. Haile (medical director), Dr. Mogos and Dr. Mokonnon. My wife worked during her stay in both hospitals with the operating room staff. Activities General We stayed the first 21/2 weeks in Hailbet Hospital. Then we went to Glas, there my wife worked for 1 week and I stayed there for 4 weeks. I closed the stage with another 2 weeks in Halibet. During the hole time the patient population was focussed on low back pain problems. In the assessment of outpatients I have seen during the 8 weeks 400 patients and about 70% of them were presented with low back pain problems. First I had to introduce a standardised examination format and a format how to read an MRI correctly. The collegues learned to examin the patient correctly, to take out the main information from conventional x-rays and also to read the MRI correctly. The assessement of the patients was done by the local doctors under my supervision. On this base all surgeon were then able to develop the indication for a conservative tratement or a surgical intervention. At the end of the stage we realised a small video for the correct neurological examination of a patient wich will be distributed in all Hospitals with the examination and MRI format. Beside the low back pain problematic the other main medical conditions were in Halibet Hospital traumtological problems and in Glas shoulder and knee instability and in a small number post war injuries. In the OR a small number of the patients was operated by myself. The bulk of patients was operated by the local doctors and I assisted them. The training in both hospitals consited in in teaching of surgical anatomy, principals of reduction and techniques of fixation, techniques of minimal invasive disectomie and postoperative and conservative treatement of low back pain patients. Halibet Hospital

2 As mentioned before the bulk of patients were traumatoliogical cases in the OR, in the assessment of the outpatients low back pain problems. I mainly worked with Dr. Semere at Halibet Hospital. In the OR I tried to transmit techniques of fracture management, as for example mininvasive techniques with loking plates (done with ordinary DCP plates), indirect reduction techniques (for example with condylar plates). The other pillar was to demonstrate and discuss surgical approaches and the anatomy in different cases (f.e. posterior approach th the acetabulum). In the outpatient assessement the technique of examination especially for spine patients was in the foreground. Glas Military Hospital In Glas the outpatient assessement was focussed on low back pain patients. In a smaller number I have seen patients with shoulder and knee instabilities. During this sessions we selected the patients for the operations. With the examination and MRI format for low back spine problems we developped a good instrument to select patients for a surgical or conservative treatement. On the spine we operated disc hernations by a miniinvasive way. This technique was not always practicable because we saw al lot of old hernations with large adhesions by surrounded tissues which demanded a larger approach. Also the old instruments (over 20 years old) which sometimes breakes or were not sharp enough to cut the tissue in a save way were problems which we encountered. All spine patients in Glas were operated by Dr. Haile exept one. For the fixation of the Bankart lesions we developped the Glas anker. With small k-wires we did agraffes which were introduced at the border of the glenoid with an impacter to hold the suture in place. With this method it was easier to fixe the limbus to the glenoid and we save also operation time. Meeting with the minister of health At the end of my stage I met the minister of health with Dr. Haile and Dr. Beyane (Medical director of Halibet Hospital). I explained him the aim of the reversed fellow ship and our activities in the two hospitals. We discussed also specially the problems which Dr. Spycher and me were confronted in Halibet Hospital. I elucidate him that for the continuation of the fellow ship it is very importend to have clear structures in Hailibet Hospital (head of orthopaedic unit, reorganisation of the OR etc.) and that all these measures are implemented and supported by the mimistery of health and the direction of the hospital. Otherwise it will be not possible to continue the fellowship in the future. Summary

3 The reversed fellowship was for me, my wife and I think as I got the feedback from Dr. Haile Methsun and Dr. Semere a very profilic and interesting time. We learned from each other and I m very glad that I had this opportunity to go to Eritrea and to work there. The motivation of the responsible surgeons (Dr. Haile, Dr. Mogos, Dr. Mokonnon in Glas and Dr. Semere, Dr. Solomon in Halibet) is exemplary. All the surgeons in Eritrea need the support to learn new techniques, to use the implants and to be introduced in treatement concepts. The direction of the Halibet Hospital and the ministry of health must take their responsibility and introduce clear structures and to support the collaborators at each level. The need to continue these reversed fellow ship is for me in a mean and long term view out of discussion. Operation statistics Eritrea (Halibet, Glas) M. Lottenbach 2005 Sex OP/Ass Diagnosis Intervention Halibet Traumatologie F A pertrochanteric femur fractue DHS F A lower leg fracture IMN M A lower leg fracture IMN M A lower leg fracture locking plate, less invasive M O acetabulum fracture, posterior wall plating M O wrist fracture pinning M A ulna fracture plating M A femoral neck fracture screw fixation F A posterior dislocation hip reduction M A posterior fracture dislocation hip reduction M A posterior fracture dislocation hip reduction F A open fracture ulna wound revision, rush pin M A open fracture 3 fingers pinning M O burst fracture L2 internal fixation (USS) M O proximal intraarticular tibia fracture plating M A subtrochanteric fracture condylar plate

4 M O femur fracture malunion (child) osteotomie, fixateur externe Elektiv Glas Traumatologie Elektiv M O discal hernia L4/L5 disectomie M O pseudarhrosis of med. femoral condyle revision, osteotmie, plating M A osteochondroma humerus excisicion M A spastic derformity of the foot triple arthrodeses, achilles tendon lengthnning M O valgus derformity left leg supracondylar osteotmie, bone grafting M A motion limitation after distal arthrolysis, osteophytectomie, humerus fracture M O lisfranc dislocation 14 d old open reduction, pinning M O distal radius fracture open reduction, pinning M O multifragmetarie radial head fracture open reduction, screw fixation M A disc herniation L4/L5, L5/S1 discectomie M A disc herniation L5/S1 discectomie M A disc herniation L5/S1 discectomie F A disc herniation L4/L5 discectomie, laminectomie left M A disc herniation on 3 levels laminectomie on three levels M O muscle herniation low back revision, closure M A disc herniation L1/L2, L4/L5 laminectomie on both levels M A ACL Rupture ACL replacement M A ACL Rupture ACL replacement

5 M A ACL Rupture ACL replacement M O pseudarhrosis ulna revision, plating M O chronic monteggia fracture revision, bone graft, plating M O patella pseudarthrosis revision, screw fixation M O malunion 5th finger osteotomie, pinning M O valgus deformation leg supracondylar osteotomie, bone graft plating M A fibroma foot excisicion M A fibroma foot second look M A fibroma foot third look M A a-v fistula femoralis revision M A Malunion distal radius osteomie, fixation by plating and bone graft